Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Western Avenue Surgery on 11 July 2017. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, significant events and near misses were not formally discussed and actioned as the practice held no formal clinical meetings.
• The practice had some defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Some staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, the practice did not have training records for locum staff.
• The practice nurse had not received a Disclosure and Barring Service check before starting work at the practice.
• Results from the national GP patient survey showed patients considered the practice to be performing well in some areas, but below average in most. The practice had not addressed this feedback.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat most patients and meet their needs. However, accessibility for patients with a physical disability was limited.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvements are:

• Develop effective systems and processes to ensure safe care and treatment including significant event processes being clear and reviewed, and that discussions occur to ensure that events are not missed. This should also include ensuring prescription security where they are taken from the premises.

• Develop effective systems and processes to ensure the dignity and respect of patients is maintained, including acting on patient feedback.

• Develop effective systems and processes to ensure good governance including ensuring that formal communication lines are established between clinicians.

• Develop effective systems and processes to ensure staffing is managed in line with regulations, including ensuring that all staff Disclosure and Barring Service status is checked and recorded and that photographic evidence of staff identities is retained. This should also include ensuring that staff have completed training.

In addition the provider should:

• Review clinical exception reporting at the practice which is higher than the national average.
• Ensure patients privacy is maintained when intimate examinations are carried out.
• Develop systems to identify carers so their needs can be identified and met.
• Improve access for patients with disabilities.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice